Document Detail

Possible relation of atypical parkinsonism in the French West Indies with consumption of tropical plants: a case-control study. Caribbean Parkinsonism Study Group.
MedLine Citation:
PMID:  10440304     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In Europe and North America, Parkinson's disease is the major form of parkinsonism; less than 4% of cases are progressive supranuclear palsy (PSP) and about 20% are atypical parkinsonism. The distribution of these subgroups is different in the French West Indies. We aimed to define the clinical and demographic specificity of these disorders in Guadeloupe and to investigate a postulated link with consumption of herbal tea and fruits from the Annonaceae family (Annona muricata and Annona squamosa), which contain neurotoxic benzyltetrahydroisoquinoline alkaloids. METHODS: Between September, 1996, and August, 1998, 87 consecutive patients with parkinsonism were referred to the single neurological department in Guadeloupe. After detailed clinical, neurophysiological, cognitive, and neuroradiological assessment, they were classified by generally accepted criteria as having Parkinson's disease, PSP, or atypical parkinsonism. We compared the amount of tropical fruits and herbal tea consumed by the various parkinsonian subgroups and by frequency-matched controls (patients with benign symptoms and no neurodegenerative disease). FINDINGS: Of the 87 patients, 22 had Parkinson's disease, 31 had PSP, 30 had atypical parkinsonism, and four had atypical parkinsonism associated with motor neuron disease, 44 of the patients with PSP or atypical parkinsonism were male. The patients with atypical parkinsonism had symmetrical rigidity and bradykinesia, and no levodopa peak-dose dyskinesias. Patients with PSP differed from those with atypical parkinsonism because they had supranuclear vertical down-gaze palsy, severe gait and balance problems, and frontal-lobe syndrome. 29 patients with PSP reported regular consumption of pawpaw fruit, and 26 drank herbal tea. 30 patients with atypical parkinsonism reported regular consumption of pawpaw fruit, and 24 drank herbal tea. Both of these groups consumed significantly more fruit and herbal tea than patients with Parkinson's disease (fruit: odds ratio 23.6; herbal tea: 28.2); and controls (fruit: 20.7; herbal tea: 6.48). INTERPRETATION: Our study confirms the over-representation of atypical parkinsonism and PSP in patients with parkinsonism in the French West Indies. Chronic exposure to neurotoxic alkaloids could be an important aetiological factor because these compounds induce parkinsonism in animals. A larger epidemiological study, to clarify the link between these fruits with atypical parkinsonism and PSP, is proposed.
D Caparros-Lefebvre; A Elbaz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Lancet     Volume:  354     ISSN:  0140-6736     ISO Abbreviation:  Lancet     Publication Date:  1999 Jul 
Date Detail:
Created Date:  1999-08-23     Completed Date:  1999-08-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  281-6     Citation Subset:  AIM; IM    
Department of Neurology, Centre Hospitalier Universitaire, des Antilles et de la Guyane, Pointe à Pitre, Guadeloupe, French West Indies.
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MeSH Terms
Aged, 80 and over
Alkaloids / poisoning
Beverages / adverse effects*
Case-Control Studies
Fruit / adverse effects*,  chemistry
Guadeloupe / epidemiology
Isoquinolines / poisoning
Middle Aged
Parkinson Disease / diagnosis,  epidemiology
Parkinson Disease, Secondary / diagnosis,  epidemiology,  etiology*
Plants / chemistry
Supranuclear Palsy, Progressive / diagnosis,  epidemiology,  etiology*
Reg. No./Substance:
0/Alkaloids; 0/Isoquinolines
Comment In:
Lancet. 1999 Oct 23;354(9188):1474   [PMID:  10543696 ]
Lancet. 1999 Oct 23;354(9188):1473-4   [PMID:  10543695 ]
Lancet. 1999 Oct 23;354(9188):1472-3   [PMID:  10543694 ]

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